5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director...
-
Upload
lawrence-may -
Category
Documents
-
view
213 -
download
0
Transcript of 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director...
![Page 1: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/1.jpg)
5 mins on last days of lifeand palliative care
emergencies !
5 mins on last days of lifeand palliative care
emergencies !
Dr. Ros Taylor
Hospice Director
Hospice of St. Francis Berkhamsted
June 2012
![Page 2: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/2.jpg)
Know who to ring !!!Know where the resources are !
• Mount Vernon Cancer Network Advice 01923 844281
• Hospices….open all hours
• Peri-patetic Marie Curie Nurse
• OOH District Nurses
![Page 3: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/3.jpg)
Last moments of lifeLast moments of life
• Precious
• Very symbolic to be together
• Hours at bedside - focus on separation and memories
![Page 4: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/4.jpg)
![Page 5: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/5.jpg)
Acknowledge death is nearAcknowledge death is near
• Fundamental to good management Allows symptom control and decisions Allows final business and acceptance
• If ignore closeness to death No care of dying Inappropriate treatment
![Page 6: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/6.jpg)
Surprise Question
“ would I be surprised if this patient died in ………..a few days ??”
![Page 7: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/7.jpg)
Anticipate
We can see the future…..often
![Page 8: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/8.jpg)
Clinical intuition
• Declining mobility• Distracted and distant• Breathless • Difficulty swallowing• Circulation changes• PEOPLE KNOW !!
![Page 9: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/9.jpg)
Limit treatment to :Limit treatment to :
• Analgesia
s/c diamorphine or morphine
• Sedation if needed
s/c midazolam or levomepromazine
• Anticholinergic
s/c glycopyrronium or hyoscine
![Page 10: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/10.jpg)
Just in Case Boxes
• 3-5 days of
–Analgesia
–Sedation
–Drying agent
–Anti-nausea
![Page 11: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/11.jpg)
Stopping medicationStopping medication
• Stop futile medication - treat symptoms only
• If unable to swallow - use parenteral route
![Page 12: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/12.jpg)
Syringe driversSyringe drivers
• When to use Unable to take oral medication Nausea and vomiting Dysphagia Unconscious
• What to use
![Page 13: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/13.jpg)
Fentanyl in the last daysFentanyl in the last days
• Keep patch on at same dose death
• Add extra analgesia as morphine in a driver
![Page 14: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/14.jpg)
The Pain of it all
![Page 15: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/15.jpg)
Managing terminal painContinue analgesia until deathManaging terminal pain
Continue analgesia until death
If not swallowingthen s/c infusion of diamorphine with 1/3 of
previous oral morphine dose
Breakthrough pain Use sixth of 24hr opioid dose
If not had opioids Then 10 - 20mg diamorphine s/c per 24 hrs Plus anti-emetic
![Page 16: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/16.jpg)
Terminal DyspnoeaTerminal Dyspnoea
INSPIRE
EXPIRE
Powerful words
![Page 17: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/17.jpg)
When midazolam fails
• Short acting 1-3 hrs
• amnesic not analgesic
• in some people acts like alcohol– increase agitation and aggression
• Alcohol and benzo use affects its activity
• try Nozinan or Phenobarbitone
![Page 18: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/18.jpg)
Terminal restlessnessTerminal restlessness
• Look for reversible cause Bladder, bowel, pain, hypoxia
• Best drug is midazolam 2.5mg – 5mg s/c midazolam
20 mg++ per 24 hrs midazolam Or lorazepam SL
![Page 19: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/19.jpg)
Sedation
“If you want to die in your sleep you have to sleep first..”
![Page 20: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/20.jpg)
Liverpool Care Pathway for the Dying
Liverpool Care Pathway for the Dying
?? Stairway to HeavenOr
?? Improve everyones care
to a minimum standard
![Page 21: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/21.jpg)
![Page 22: 5 mins on last days of life and palliative care emergencies ! Dr. Ros Taylor Hospice Director Hospice of St. Francis Berkhamsted June 2012.](https://reader036.fdocuments.us/reader036/viewer/2022070415/5697c02b1a28abf838cd86fe/html5/thumbnails/22.jpg)
Know who to ring !!!Know where the resources are !
• Mount Vernon Cancer Network Advice 01923 844281
• Hospices….open all hours
• Peri-patetic HUC Marie Curie Nurse
• OOH District Nurses